government site. MeSH Read our. Any metal that comes into contact with body tissues will corrode to some degree. 2016 Sep;31(9):1910-5. In most cases, patients have no issues with the hardware. 2022 Dec 19;24:153-170. doi: 10.1016/j.bioactmat.2022.12.012. and transmitted securely. discharge. These screws normally contain 14% nickel, 20% . High resolution DLP stereolithography to fabricate biocompatible hydroxyapatite structures that support osteogenesis. These degradation products of the implant may cause increased metal hypersensitivity and implant failure. Titanium is a known metal used widely in the medical field and can cause allergic reactions with complications. With that said, some studies suggest that they may be beneficial for certain groups. Surgical realignment, metal plates & screws (made . Metals corrode in biologic systems, allowing for hapten formation. Please see our, You are being redirected to Medscape Education, Advanced Systemic Mastocytosis: Considerations to Optimize Patient Management. It is estimated that up to 17% of women and 3% of men are nickel allergic, and that about 1 to 2% are allergic to cobalt, chromium, or both. 1, pp. V. Vijayaraghavan, A. V. Sabane, and K. Tejas, Hypersensitivity to titanium: a less explored area of research, J Indian Prosthodont Soc., vol. If you notice any severe symptoms after your spine surgery, be sure to contact your surgeon. It's rare for someone to need their metal implants removed due to a metal allergy or sensitivity. Type I hypersensitivity reaction may manifest as anaphylaxis causing urticarial plaques or papules on the skin [3]. Prosthetic joints containing metals nickel, chromium, and cobalt are most likely to cause a reaction. A blood test known as a nickel lymphocyte proliferation test is used to identify nickel sensitivity. But sometimes issues do arise. Symptoms of a Reaction Unfortunately, the symptoms of metal implant sensitivity and allergy are not well defined. The skin patch test has not yet been developed as the valid standardized test for titanium allergy. The patients social history is insignificant, with no smoking or alcohol consumption. However, while both are in the "allergy family," there is an important difference worth clarifying. Cutaneous reactions to metal implants, orthopedic or otherwise, are well documented in the literature. Contact Dermatitis. Thanks so much Craig, that is good to hear! It causes delayed clinical manifestations after 48 to 72 hours [10]. Finally, the blood test could be effectively used to diagnose type IV hypersensitivity allergic reactions, including contact dermatitis or eczema reported by few studies on titanium allergy [12]. The first case of a dermatitis reaction over a stainless steel fracture plate was described in 1966. While the words "hypersensitivity" and "allergy" are often used interchangeably, they're not really the same. There is no data to support the routine use of ceramic (zirconium) or titanium implants, even in people with concerns about metal hypersensitivity. Metal hypersensitivity in patient with posterior lumbar spine fusion: a Patients can present with atopic dermatitis, pruritus, edema, urticaria, impaired healing fractures, pain, and necrosis of implants [3]. Revision to titanium THR with ceramic-on-ceramic bearing led to symptom resolution. Clinically, diagnosis of metal implant allergy is a process of excluding differential diagnoses, specifically infection. Nickel, cobalt, and chromium are the three most common metals that elicit both cutaneous and extracutaneous allergic reactions from chronic internal exposure. If you log out, you will be required to enter your username and password the next time you visit. Case presentation We present the case of a 52-year-old female patient with reoccured low back pain and sciatica after posterior lumbar decompression and fusion (PLDF) for her lumbar . and transmitted securely. Casein Allergy. Bookshelf If you notice any severe symptoms after your spine surgery, be sure to contact your surgeon. 97100, 2017. Unfortunately, the symptoms of metal implant sensitivity and allergy are not well defined. This causes type IV hypersensitivity reaction through sensitization of T lymphocytes and macrophages. M. Hosoki, K. Nishigawa, T. Tajima, M. Ueda, and Y. Matsuka, Cross-sectional observational study exploring clinical risk of titanium allergy caused by dental implants, Journal of Prosthodontic Research, vol. Necessary cookies are absolutely essential for the website to function properly. The CT impressions showed no signs of bowel obstruction or colitis; however, it was evident that a portion of a pigtail drainage catheter was lodged within the cecum (Figure 2). Especially, in our case, the patients extensive past medical history and multiple overlapping medical conditions delayed her diagnosis of RFB and caused her significant life distress. One frequently encountered metal sensitivity is to nickel. 15, 2020. Cross-sectional observational study exploring clinical risk of titanium allergy caused by dental implants. 2023 Dotdash Media, Inc. All rights reserved, Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. V. A. Zejnullahu, B. X. Bicaj, V. A. Zejnullahu, and A. R. Hamza, Retained surgical foreign bodies after surgery, Open Access Maced J Med Sci., vol. Also, more complex immune reactions may develop around the implants, resulting in pain, inflammation, and loosening. It is mandatory to procure user consent prior to running these cookies on your website. The information contained herein is subject to change without notice. As these cases are reported with metal implants including clips used in surgery, these allergic reactions can also be expected with staples. We present a case of a 28-year-old female with a chronic history of intermittent abdominal pain aggravated due to titanium allergy and retained foreign surgical body. However, all the symptoms were resolved after the removal of the offending agent [57]. She reported symptoms including a low-grade fever, nausea, vomiting, diarrhea, and joint pain. 2, pp. Can a Nickel Allergy Cause an Autoimmune Disease? Metal hypersensitivity and total knee arthroplasty. Revision to a ceramic-on-ceramic THR led to symptom resolution. Iodine is essential for thyroid function, and an allergy to it would be life . Discussion: Keywords: 8600 Rockville Pike 2021;9(8):3109-3117.e1. 2022 Nov 28;13:1050315. doi: 10.3389/fimmu.2022.1050315. Dizziness or fainting. The patient also started having low-grade fever, nausea, vomiting, joint pain, diffuse rash, and fatigue. This corrosion causes the formation of metal ions that ultimately trigger the inflammatory immune response. The MELISA test has been known to be a more sensitive test to metal allergy but lacks specificity in the proliferation of lymphocytes [3]. Although inflammation is the body's natural response to anything it considers foreign and harmful, it can cause pain and other symptoms if it occurs in the absence of a genuine threat. Some orthopedic implants contain small amounts of nickel, and there's been a concern that this may be an issue for nickel-sensitive people. These cookies do not store any personal information. When they do occur, titanium allergy symptoms can range from mild to severe and can include: loosening of the implants (or implant failure) rash or hives. In an aging population, the putative association between metal allergy and device failure due to DTH may be a problem of growing significance. To comment please, Comments on Medscape are moderated and should be professional in tone and on topic. Jonathan Cluett, MD, is board-certified in orthopedic surgery. Staples are used to hold skin together in order to clsoe a surgical incision or wound that is too big or complex to close with traditional sutures or stitches. 1. The abdominal pain is associated with titanium allergy reaction from previously inserted titanium-based surgical clips. Titanium is extensively used in devices such as dental implants, pacemakers, and body piercing. Allergic reactions can range from mild to severe. 2023 Feb 19;14(2):116. doi: 10.3390/jfb14020116. Nickel is one of the most common allergens, and can cause local contact dermatitis characterized by itching and skin reddening. Late onset infection can occur in some cases where you have some focus of infection causing bacteremia,and the sign symptoms include, redness. Pseudotumors posterior to joints (4 mo apart), Pain (15/17); lump (6/17); nerve irritation or palsy (5/17); dislocation (2/17); instability (2/17); rash (1/17); none (2/17). Revision to titanium alloy with ceramic-on-ceramic bearing led to symptom resolution. Titanium Rejection Symptoms | Colgate She was diagnosed with pneumonia twice followed by two sinusitis episodes from January 2020 to March 2020. She also reported low-grade fever, nausea, vomiting, joint pain, bloody diarrhea, and inability to keep her food down. Unable to load your collection due to an error, Unable to load your delegates due to an error. Moreover, titanium has been described to activate macrophages through phagocytosis to cause the release of pro- and anti-inflammatory cytokines [9]. Metal Hypersensitivity After Spinal Instrumentation: When to Suspect Many people have known skin sensitivities to various metals. Eczema most severe around the implant site, 3. 2022 Aug 8;17(8):e0272283. In other words, an orthopedic surgeon has to first exclude the more likely causes of continued pain or swelling around an implant such as infection, instability, implant loosening or tendinitis before considering hypersensitivity associated with an implant. G. Forte, F. Petrucci, and B. Bocca, Metal allergens of growing significance: epidemiology, immunotoxicology, strategies for testing and prevention, Inflammation & Allergy Drug Targets, vol. Despite repeated attempts by researchers and clinicians to further understand this difficult area of medicine, the association between metal sensitivity and cutaneous allergic reactions remains to be fully understood. The https:// ensures that you are connecting to the Co = cobalt; Cr = chromium; Mo = molybdenum; Ni = nickel. FOIA The authors declare that they have no competing interests. Would you like email updates of new search results? The pain was sharp and stabbing in nature and radiated from the umbilicus, and the patient rated the pain 10/10 on a scale, causing her significant discomfort. The use of sutures are said to be beneficial in laparoscopic or robotic assisted cholecystectomies. 2011American Contact Dermatitis Society. Fe = iron; Co = cobalt; Cr = chromium; N/A = not applicable; Ni = nickel. doi:10.5435/JAAOS-D-14-00290, Saccomanno MF, Sircana G, Masci G, et al. Titanium: a new allergen]. Metal hypersensitivity reactions to orthopedic implants. Accessibility Allergic or sensitive to metal? By Jonathan Cluett, MD CT scan was promptly ordered to rule out the severe complication of toxic megacolon as a result of C. difficile infection. This site needs JavaScript to work properly. 59, no. Vomiting or diarrhea. Stainless Steel material that is typically used in skin stapling and surgical clips. Blog Hypersensitivity Reactions to Metallic Implants - Medscape More surgical procedures are closed using skin glues, which are also capable of triggering a blistering contact dermatitis. If that includes you, make sure your healthcare provider knows. doi:10.1016/j.jaip.2020.12.068, Wang Y, Dai S. Structural basis of metal hypersensitivity. Allergic to Metals? 6 Surprising Places They May Lurk In general, allergic risk of titanium material is smaller than that of other metal materials. He exhibited allergic symptoms (eczema) after orthopedic surgery. However, other metal ions as well as bone cement components can cause such hypersensitivity reactions. The site is secure. That said, in the discussion of metal implants in the body, these words are often used in the same discussion. JArthroplasty. It was only during a visit to the doctor in 2021 when she had a metal allergy test conducted, and it came back positive for reactivity to nickel, copper, and mercury. Systemic Nickel Allergy after Internal Fixation of a Bunionectomy Case Reports and SeriesSystemic Nickel Allergy after Internal Fixation of a Bunionectomy. 1, pp. Telephone: 1.800.234.1826 Having a metal allergy or sensitivity doesn't mean getting a metal implant like a surgical screw, plate, or joint replacement is entirely off limits or that the body will reject it. You will receive email when new content is published. Juliana L. Basko-Plluska; Jacob P. Thyssen; Peter C. Schalock. The joint never fully fused and I had the stainless steel replaced first with a single titanium screw and cadaver bone graft and then a third . 2013, no. Metal sensitivities and allergies have been implicated in some situations involving pain or problems with orthopedic implants. 2017;13(1):129. Usually retained foreign bodies are found after complaints such as pain, infections and a palpable mass. Common symptoms of MHS reactions include localized pain, swelling, redness, warmth, loosening, draining, itching/burning, and implant instability. Surgical implants are essential elements of repair procedures to correct worn out joints, damaged spinal components, heart and vascular disease, and chronic pain. J Allergy Clin Immunol Pract. Bone Joint J. ALVAL = aseptic lymphocytic vasculitisassociated lesions; Co = cobalt; Cr = chromium; CT = computed tomography; F = female; M = male; MOM = metal-on-metal; Ref. We describe a case of chronic abdominal pain, which is potentially complicated by retained titanium surgical clips and subsequently a retained portion of a pigtail catheter. An official website of the United States government. The most common symptoms for patients with MHS-associated failures are localized soft tissue reaction including delayed wound healing and/or recurrent wound issues. To confirm, the patient was further ordered for memory lymphocyte immunostimulation assay (MELISA) that also showed equivocal results for titanium allergy. Still, cases have been reported, and some people's symptoms have gone away after removal. The patient had undergone a laparoscopic removal of the eight clips used in her past surgery, and since then, her symptoms have resolved. 2022 Dec 22;16(1):115. doi: 10.3390/ma16010115. Signs & Symptoms of an Allergic Reaction | Complete Care So, skin testing for nickel, cobalt, and chromium hypersensitivity has limited value in diagnosing DHT. Metals including titanium can form haptenic antigens in their ionic form upon bonding with human cell native proteins and have the ability to potentiate degranulation of basophils and mast cells [3]. Cutaneous and systemic hypersensitivity reactions to metallic implants. A rash after surgery may be due to contact with irritants or an allergic reaction to a medication. Bethesda, MD 20894, Web Policies Restenosis occurred predominantly in patients with negative patch-test reaction to nickel. 2019;10(2):63-70. doi:10.5312/wjo.v10.i2.63, Kahlenberg CA, Nwachukwu BU, McLawhorn AS, Cross MB, Cornell CN, Padgett DE. Nickel allergy to orthopaedic implants: A review and case series doi:10.1007/s11420-016-9514-8. This will improve the patients quality of life and prevent serious complications. Khodaei T, Schmitzer E, Suresh AP, Acharya AP. *List may not be exhaustive. Painful Hardware - FootEducation Normal pelvic radiography. -. > 1 stenosis = 60 (case) 1 stenosis = 68 (control), Bare metal stainless steel 316L stents; 19% (24/128) of all patients were nickel positive; "24 nickel positives, 30% in study group, 9% in control group (, Multivariate analysis: most significant predictor of chronic in-stent restenosis: reference vessel diameter (. Most skin reactions are eczematous and allergic in nature, although urticarial, bullous, and vasculitic eruptions may occur. Titanium: a review on exposure, release, penetration, allergy, epidemiology, and clinical reactivity. It also sheds light on retained foreign bodies as a possible cause of abdominal pain in patients who have gone through various surgical procedures in the past. Epub 2016 Mar 29. 12, no. The patient has allergic symptoms reported from IV contrast, nickel, titanium, iodine, metoclopramide, and oxalate. They always include a percentage of nickel, which is a known allergen. Contact Dermatitis. Bethesda, MD 20894, Web Policies This is why it is important to exclude all other causes of joint inflammation and pain before exploring the next step in treatment: revision surgery. sharing sensitive information, make sure youre on a federal does it exst? Dull aching pain, swelling, followed by supracondylar fracture. M. Tu and Y. Wu, Multiple allergies to metal alloys, Dermatologica Sinica, vol. doi: 10.7759/cureus.30625. Therefore, these materials are generally used only when metal implants have been removed, or if you have a high likelihood of problems with a metal implant. HHS Vulnerability Disclosure, Help If a glass of milk or slice of pizza causes swollen lips, hives, or other symptoms, you may have an allergy to casein, a protein in milk. Staged revision resulted in pain relief, but nerve palsy did not recover. P. H. Wu, J. H. Chen, and K. E. Chu, Successful endoscopic management of double iatrogenic perforations induced by endoscopic retrograde cholangiopancreatography and computed tomography-guided colon drainage, Case Reports in Gastroenterology, vol. Metal Allergy/Sensitivity Symptoms Symptoms of an allergy or sensitivity to metal in a knee replacement include: 7 Chronic (persistent) knee pain Chronic or intermittent knee redness, warmth, and swelling Knee stiffness and reduced range of motion Itchy, scaly skin patches around the affected joint sharing sensitive information, make sure youre on a federal The titanium screws used in the orthopedic surgery that he underwent were removed 1 year later, but the eczema remained. Patients can also lower their risk for other complications after a surgery with staples by following postoperative care instructions from their surgeon. Some of the most common materials found in staples include: Titanium is generally preferred because it is flexible, lightweight, and less likely to cause inflammation or infection in a patient. Thank you, {{form.email}}, for signing up. I'm going for a follow up next week, I was just wondering if it was a common issue, & I'd be calling for an emergency . Edina, Patients can present with atopic dermatitis, pruritus, edema, urticaria, impaired healing fractures, pain, and necrosis of implants [ 3 ]. Bilateral pseudotumors anterior to joints (10 mo apart). Revision to conventional THR led to resolution of pain. Symptoms reported have included: Having a skin sensitivity to a particular metal is not thought to correlate well to having sensitivities to implanted metals. These cookies will be stored in your browser only with your consent. However, the skin-patch test is still not the best diagnostic modality due to failure in positive reaction to most titanium allergy cases [3]. It requires a case-by-case evaluation weighing the potential benefits and risks. government site. Clinic Locations. eCollection 2022. Popiolek I, Blasiak M, Kozak A, Pietak E, Bulanda M, Porebski G. Diagnostics (Basel). No difference in positive patch-test results between restenosis and nonrestenosis groups after stent implantation (9% vs 10%). Allergy symptoms, which depend on the substance involved, can affect your airways, sinuses and nasal passages, skin, and digestive system. It may be necessary to remove the spinal hardware to avoid any further complications. Nam D, Li K, Riegler V, Barrack RL. There are more than 28 million surgical procedures with up to 1500 cases of retained foreign bodies estimated in the United States per year [13]. The titanium screws used in the orthopedic surgery that he underwent were removed 1 year later, but the eczema remained. 4, pp. Implant-related Allergic Contact Dermatitis, Cobalt-chromiummolybdenum steel (ASTM F75), 1. So a person who has already had spinal hardware put in place can potentially develop an allergy to it years down the line. Plastic used if the patient is allergic to metals found in other medical staples. Hypersensitivity Reactions to Metallic Implants eCollection 2023. J. S. Gammie, M. C. Banks, C. R. Fuhrman et al., The pigtail catheter for pleural drainage: a less invasive alternative to tube thoracostomy, JSLS., vol. Patients who have pain around metal implants that is also associated skin changes (eczema) should be evaluated for possible metal sensitivity. Signs and symptoms of metal hypersensitivity can range from mild to severe and generalized. complete resolution; 2/17 awaiting revision; 3/17 coping well. On the other hand, another rare case of a female patient was also the topic of one case report. A number of studies also suggest a conversion to suturing in place of surgical stapling in order to avoid allergic reactions and other potential complications after surgery. We discuss the presentation, investigations, and treatment of this unusual case. The patient started having another episode of intermittent right lower quadrant (RLQ) pain starting in January 2020. The woman also had a cholecystectomy back in 2007, and thats when she began experiencing symptoms including joint pain and tenderness, cramps, dry skin and hair, racing heart, hand tremors, and high blood pressure, among many others. 3, no. The most common symptoms of hypersensitivity to metals include: hives blistering of the skin rash swelling reddening of skin depression joint pain chronic fatigue fibromyalgia (widespread pain without known cause) chronic inflammation cognitive impairment Highest odds ratio for restenosis (5.41) were in nickel positives. A case of allergic reaction to surgical metal clips inserted for postoperative . Please enable it to take advantage of the complete set of features! 2013 ;55(1-3):83-90. doi:10.1007/s12026-012-8351-1, Schoon J, Ort MJ, Huesker K, Geissler S, Rakow A. This case highlights the variable presentation of titanium allergy that clinicians should be vigilant for. Hypersensitivity or allergy can occur after contact with various metals. However, it indeed seems titanium allergy had a significant role in her abdominal discomfort owing to her positive allergy test results further proving titanium hypersensitivity in this patient. The patients most appropriate for testing include (1) pre-operative joint replacement patients with a prior history of skin reactions to metal jewelry, jean snaps, watch bands, metal glass frames, artificial nails, or skin glue; (2) post-operative joint replacement failure patients needing revision without an obvious cause such as infection or mechanical incompatibility; and (3) post-operative cardiac or neurological patients with localized rash, pain, swelling, or inflammation near or over the implant. Metal allergies and sensitivities can be assessed using skin patch testing. Red, swollen, watery eyes -- a condition known as allergic conjunctivitis. Fortunately, people who's implant problems were a clear result of metal sensitivity usually find immediate relief after removal. Runny nose. Jonathan Cluett, MD, is board-certified in orthopedic surgery. Titanium has also been reported as an allergen in a few studies, causing type I or type IV hypersensitivity reactions [3]. Cara Beth Lee, MD, is a board-certified orthopedic surgeon and Assistant Medical Director at Comagine Health in Washington. Changed to titaniumplated endoprostheses; symptoms resolved. The use of these implants is considered experimental and should be done with extreme caution. These assessments do not indicate that Dr. Sinicropi has performed these specific surgeries. These allergens are also the most important in reactions to spinal surgeries. Please enable it to take advantage of the complete set of features! [1] Metal allergy is mainly caused by prolonged or repeated skin exposure to consumer items such as jewelry, cell phones,[2] clothing fasteners,[3] and leather goods. Why Is a Reaction to Knee Replacement Delayed? Medical ID Cards to Identify Metal Implants for the TSA, Trapeziectomy: Everything You Need to Know, Removing Pins and Other Surgical Implants, Problems With Metal-on-Metal Hip Replacements, Causes and Risk Factors of Contact Dermatitis, Why the Material Used for Hip Replacement Implants Matters, Allergy in total knee arthroplasty: a review of the facts, Metal hypersensitivity reactions to orthopedic implants, Biological responses to metal implants: 2019. Metal allergies are becoming more recognized within the surgical field. -, Lancet. Erythema, swelling, sterile effusions, pain with limitation of movement. However, in October 2020, the patient started having new symptoms of watery, nonbloody diarrhea associated with her chronic RLQ pain. However, several studies have reported cases of metal allergy caused by titanium-containing materials. The patient did not report any screening for immunodeficiency in the past. Among different RFB, sponges are one of the most common retained foreign bodies in the abdomen, pelvis, and retroperitoneal cavities [13]. You must declare any conflicts of interest related to your comments and responses. 2018;14(2):192201. eCollection 2022 Oct. [Orthopedic surgical implants and allergies: joint statement by the implant allergy working group (AK 20) of the DGOOC (German association of orthopedics and orthopedic surgery), DKG (German contact dermatitis research group) and dgaki (German society for allergology and clinical immunology)]. An Investigation into the Potential of Turning Induced Deformation Technique for Developing Porous Magnesium and Mg-SiO. If you are suffering from symptoms of adverse reactions to staples, seek immediate medical attention. This rapid expansion of titanium-containing products has increased percutaneous and permucosal exposure of titanium to the population. 1 Patients with MHS reactions to implants typically have prolonged eczematous dermatitis.8 Although the majority of MHS reactions are localized, more widespread inflammation has been reported. Sinus Issues. Can you be Allergic to Spine Hardware? | Dr. Stefano Sinicropi Titanium hypersensitivity. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams. Clipboard, Search History, and several other advanced features are temporarily unavailable. The .gov means its official. People with suspected metal allergies or sensitivities should undergo testing prior to knee replacement surgery. An official website of the United States government.